New HIV infections halved after scale-up of HIV treatment, circumcision, in Uganda's hardest-hit district

From AIDSmap, Michael Carter and Keith Alcorn report on the Rakai Community Cohort Study.

The rate of new HIV infections has halved since 2011 in a Ugandan community following large increases in male circumcision, antiretroviral treatment and viral suppression, Frank Kagaayi of the Rakai Health Sciences Program told the Conference on Retroviruses and Opportunistic Infections in Boston on Tuesday.

Dr Kagaayi was presenting results from the Rakai Community Cohort Study, focusing on repeat surveys of one fishing village with a very high prevalence and incidence of HIV infection. The Rakai Community Cohort covers around 50 communities in the Rakai district in southern Uganda.

The prospective study recruited 5005 individuals residing in a fishing community on Lake Victoria in Rakai. All were aged between 15 and 49 years.

A total of 1823 participants were HIV-negative at baseline and these individuals contributed a total of 5188 person-years of follow-up. During this time, there were 134 incident HIV cases.

Over the study period, the proportion of patients taking ART increased four-fold from, 19% to 81%. This increase was seen in all age groups, although coverage remained lower in young women aged 24 and under and in men under 30.

"By 2017, population viral suppression had increased from 33% to 78%. There was no change in reported sexual risk behaviour."

Therve was also a large increase in the coverage of male circumcision, from 39% to 63%.

By 2017, population viral suppression had increased from 33% to 78%. There was no change in reported sexual risk behaviour.

Overall HIV incidence more than halved from 3.97 per 100 person-years in 2011 to 1.61 per 100 person-years in 2017, a 58% reduction in incidence. Similar declines in incidence occurred in women (62% reduction) and men (55% reduction).

Substantial falls in HIV incidence were recorded in all age groups, especially those aged 15 to 24 years, among whom incidence declined from 5.53 to 1.87 per 100 person years.

These falls in incidence were accompanied by a substantial fall in overall HIV prevalence, which declined from 41% to 36% over the study period.

The investigators conclude that rollout of ART and male circumcision was accompanied by a 58% reduction in HIV incidence between 2011 and 2017 in this community with an extremely high HIV prevalence. They note that their findings are amongst the first to show that combination HIV prevention can successfully reduce HIV incidence in a hyperendemic community.

“These results suggest that HIV treatment and prevention interventions can be rapidly scaled and have substantial population-level impact on HIV incidence in high prevalence settings,” comment the researchers.

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